Kona Community Hospital

All Charges

Charge

Type

Setting

Price

CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DECOMP

Facility

$10,517.44

Service Code	APR-DRG 3212
Min. Negotiated Rate	$10,517.44
Max. Negotiated Rate	$10,517.44
Rate for Payer: AlohaCare Medicaid	$10,517.44
Rate for Payer: Hawaii Medical Service Association ABD	$10,517.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,517.44
Rate for Payer: Kaiser Permanente Medicaid	$10,517.44
Rate for Payer: Ohana Health Plan Medicaid	$10,517.44
Rate for Payer: UnitedHealthcare Medicaid	$10,517.44

CERVICAL SPINAL FUSION WITH CC

Facility

$50,986.31

Service Code	MSDRG 472
Min. Negotiated Rate	$38,749.37
Max. Negotiated Rate	$50,986.31
Rate for Payer: AlohaCare Medicare	$38,749.37
Rate for Payer: Devoted Health Medicare	$42,624.31
Rate for Payer: Hawaii Medical Service Association Commercial	$50,986.31
Rate for Payer: Hawaii Medical Service Association Medicare	$38,749.37
Rate for Payer: Humana Medicare	$38,749.37
Rate for Payer: Kaiser Permanente Commercial	$50,820.22
Rate for Payer: Kaiser Permanente Medicare	$38,749.37
Rate for Payer: Ohana Health Plan Medicare	$38,749.37
Rate for Payer: UnitedHealthcare Medicare	$38,749.37

CERVICAL SPINAL FUSION WITH MCC

Facility

$83,295.07

Service Code	MSDRG 471
Min. Negotiated Rate	$62,967.48
Max. Negotiated Rate	$83,295.07
Rate for Payer: AlohaCare Medicare	$63,510.77
Rate for Payer: Devoted Health Medicare	$69,861.85
Rate for Payer: Hawaii Medical Service Association Commercial	$62,967.48
Rate for Payer: Hawaii Medical Service Association Medicare	$63,510.77
Rate for Payer: Humana Medicare	$63,510.77
Rate for Payer: Kaiser Permanente Commercial	$83,295.07
Rate for Payer: Kaiser Permanente Medicare	$63,510.77
Rate for Payer: Ohana Health Plan Medicare	$63,510.77
Rate for Payer: UnitedHealthcare Medicare	$63,510.77

CERVICAL SPINAL FUSION WITHOUT CC/MCC

Facility

$46,791.69

Service Code	MSDRG 473
Min. Negotiated Rate	$32,109.87
Max. Negotiated Rate	$46,791.69
Rate for Payer: AlohaCare Medicare	$32,109.87
Rate for Payer: Devoted Health Medicare	$35,320.86
Rate for Payer: Hawaii Medical Service Association Commercial	$46,791.69
Rate for Payer: Hawaii Medical Service Association Medicare	$32,109.87
Rate for Payer: Humana Medicare	$32,109.87
Rate for Payer: Kaiser Permanente Commercial	$42,112.43
Rate for Payer: Kaiser Permanente Medicare	$32,109.87
Rate for Payer: Ohana Health Plan Medicare	$32,109.87
Rate for Payer: UnitedHealthcare Medicare	$32,109.87

CESAREAN SECTION WITHOUT STERILIZATION WITH CC

Facility

$19,430.24

Service Code	MSDRG 787
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$19,430.24
Rate for Payer: AlohaCare Medicare	$14,689.02
Rate for Payer: Devoted Health Medicare	$16,157.92
Rate for Payer: Hawaii Medical Service Association Commercial	$19,430.24
Rate for Payer: Hawaii Medical Service Association Medicare	$14,689.02
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: Humana Medicare	$14,689.02
Rate for Payer: Kaiser Permanente Commercial	$16,235.00
Rate for Payer: Kaiser Permanente Medicare	$14,689.02
Rate for Payer: Ohana Health Plan Medicare	$14,689.02
Rate for Payer: UnitedHealthcare Medicare	$14,689.02
Rate for Payer: University Health Alliance Commercial	$9,950.00

CESAREAN SECTION WITHOUT STERILIZATION WITH MCC

Facility

$23,865.03

Service Code	MSDRG 786
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$23,865.03
Rate for Payer: AlohaCare Medicare	$21,695.48
Rate for Payer: Devoted Health Medicare	$23,865.03
Rate for Payer: Hawaii Medical Service Association Commercial	$19,430.24
Rate for Payer: Hawaii Medical Service Association Medicare	$21,695.48
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: Humana Medicare	$21,695.48
Rate for Payer: Kaiser Permanente Commercial	$16,235.00
Rate for Payer: Kaiser Permanente Medicare	$21,695.48
Rate for Payer: Ohana Health Plan Medicare	$21,695.48
Rate for Payer: UnitedHealthcare Medicare	$21,695.48
Rate for Payer: University Health Alliance Commercial	$9,950.00

CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC

Facility

$17,212.40

Service Code	MSDRG 788
Min. Negotiated Rate	$12,610.87
Max. Negotiated Rate	$17,212.40
Rate for Payer: AlohaCare Medicare	$12,610.87
Rate for Payer: Devoted Health Medicare	$13,871.96
Rate for Payer: Hawaii Medical Service Association Commercial	$17,212.40
Rate for Payer: Hawaii Medical Service Association Medicare	$12,610.87
Rate for Payer: Humana Medicare	$12,610.87
Rate for Payer: Kaiser Permanente Commercial	$16,539.30
Rate for Payer: Kaiser Permanente Medicare	$12,610.87
Rate for Payer: Ohana Health Plan Medicare	$12,610.87
Rate for Payer: UnitedHealthcare Medicare	$12,610.87

CESAREAN SECTION WITH STERILIZATION WITH CC

Facility

$19,430.24

Service Code	MSDRG 784
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$19,430.24
Rate for Payer: AlohaCare Medicare	$13,943.25
Rate for Payer: Devoted Health Medicare	$15,337.58
Rate for Payer: Hawaii Medical Service Association Commercial	$19,430.24
Rate for Payer: Hawaii Medical Service Association Medicare	$13,943.25
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: Humana Medicare	$13,943.25
Rate for Payer: Kaiser Permanente Commercial	$16,235.00
Rate for Payer: Kaiser Permanente Medicare	$13,943.25
Rate for Payer: Ohana Health Plan Medicare	$13,943.25
Rate for Payer: UnitedHealthcare Medicare	$13,943.25
Rate for Payer: University Health Alliance Commercial	$9,950.00

CESAREAN SECTION WITH STERILIZATION WITH MCC

Facility

$35,520.49

Service Code	MSDRG 783
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$35,520.49
Rate for Payer: AlohaCare Medicare	$32,291.35
Rate for Payer: Devoted Health Medicare	$35,520.49
Rate for Payer: Hawaii Medical Service Association Commercial	$19,430.24
Rate for Payer: Hawaii Medical Service Association Medicare	$32,291.35
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: Humana Medicare	$32,291.35
Rate for Payer: Kaiser Permanente Commercial	$16,235.00
Rate for Payer: Kaiser Permanente Medicare	$32,291.35
Rate for Payer: Ohana Health Plan Medicare	$32,291.35
Rate for Payer: UnitedHealthcare Medicare	$32,291.35
Rate for Payer: University Health Alliance Commercial	$9,950.00

CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC

Facility

$17,212.40

Service Code	MSDRG 785
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$17,212.40
Rate for Payer: AlohaCare Medicare	$12,597.71
Rate for Payer: Devoted Health Medicare	$13,857.48
Rate for Payer: Hawaii Medical Service Association Commercial	$17,212.40
Rate for Payer: Hawaii Medical Service Association Medicare	$12,597.71
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: Humana Medicare	$12,597.71
Rate for Payer: Kaiser Permanente Commercial	$16,235.00
Rate for Payer: Kaiser Permanente Medicare	$12,597.71
Rate for Payer: Ohana Health Plan Medicare	$12,597.71
Rate for Payer: UnitedHealthcare Medicare	$12,597.71
Rate for Payer: University Health Alliance Commercial	$9,950.00

CESAREAN SECTION W/O STERILIZATION

Facility

$10,064.32

Service Code	APR-DRG 5404
Min. Negotiated Rate	$10,064.32
Max. Negotiated Rate	$10,064.32
Rate for Payer: AlohaCare Medicaid	$10,064.32
Rate for Payer: Hawaii Medical Service Association ABD	$10,064.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,064.32
Rate for Payer: Kaiser Permanente Medicaid	$10,064.32
Rate for Payer: Ohana Health Plan Medicaid	$10,064.32
Rate for Payer: UnitedHealthcare Medicaid	$10,064.32

CESAREAN SECTION W/O STERILIZATION

Facility

$4,953.44

Service Code	APR-DRG 5402
Min. Negotiated Rate	$4,953.44
Max. Negotiated Rate	$4,953.44
Rate for Payer: AlohaCare Medicaid	$4,953.44
Rate for Payer: Hawaii Medical Service Association ABD	$4,953.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,953.44
Rate for Payer: Kaiser Permanente Medicaid	$4,953.44
Rate for Payer: Ohana Health Plan Medicaid	$4,953.44
Rate for Payer: UnitedHealthcare Medicaid	$4,953.44

CESAREAN SECTION W/O STERILIZATION

Facility

$6,259.17

Service Code	APR-DRG 5403
Min. Negotiated Rate	$6,259.17
Max. Negotiated Rate	$6,259.17
Rate for Payer: AlohaCare Medicaid	$6,259.17
Rate for Payer: Hawaii Medical Service Association ABD	$6,259.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,259.17
Rate for Payer: Kaiser Permanente Medicaid	$6,259.17
Rate for Payer: Ohana Health Plan Medicaid	$6,259.17
Rate for Payer: UnitedHealthcare Medicaid	$6,259.17

CESAREAN SECTION W/O STERILIZATION

Facility

$4,148.61

Service Code	APR-DRG 5401
Min. Negotiated Rate	$4,148.61
Max. Negotiated Rate	$4,148.61
Rate for Payer: AlohaCare Medicaid	$4,148.61
Rate for Payer: Hawaii Medical Service Association ABD	$4,148.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,148.61
Rate for Payer: Kaiser Permanente Medicaid	$4,148.61
Rate for Payer: Ohana Health Plan Medicaid	$4,148.61
Rate for Payer: UnitedHealthcare Medicaid	$4,148.61

CESAREAN SECTION W STERILIZATION

Facility

$4,742.53

Service Code	APR-DRG 5392
Min. Negotiated Rate	$4,742.53
Max. Negotiated Rate	$4,742.53
Rate for Payer: AlohaCare Medicaid	$4,742.53
Rate for Payer: Hawaii Medical Service Association ABD	$4,742.53
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,742.53
Rate for Payer: Kaiser Permanente Medicaid	$4,742.53
Rate for Payer: Ohana Health Plan Medicaid	$4,742.53
Rate for Payer: UnitedHealthcare Medicaid	$4,742.53

CESAREAN SECTION W STERILIZATION

Facility

$12,746.82

Service Code	APR-DRG 5394
Min. Negotiated Rate	$12,746.82
Max. Negotiated Rate	$12,746.82
Rate for Payer: AlohaCare Medicaid	$12,746.82
Rate for Payer: Hawaii Medical Service Association ABD	$12,746.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,746.82
Rate for Payer: Kaiser Permanente Medicaid	$12,746.82
Rate for Payer: Ohana Health Plan Medicaid	$12,746.82
Rate for Payer: UnitedHealthcare Medicaid	$12,746.82

CESAREAN SECTION W STERILIZATION

Facility

$4,235.76

Service Code	APR-DRG 5391
Min. Negotiated Rate	$4,235.76
Max. Negotiated Rate	$4,235.76
Rate for Payer: AlohaCare Medicaid	$4,235.76
Rate for Payer: Hawaii Medical Service Association ABD	$4,235.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,235.76
Rate for Payer: Kaiser Permanente Medicaid	$4,235.76
Rate for Payer: Ohana Health Plan Medicaid	$4,235.76
Rate for Payer: UnitedHealthcare Medicaid	$4,235.76

CESAREAN SECTION W STERILIZATION

Facility

$6,653.89

Service Code	APR-DRG 5393
Min. Negotiated Rate	$6,653.89
Max. Negotiated Rate	$6,653.89
Rate for Payer: AlohaCare Medicaid	$6,653.89
Rate for Payer: Hawaii Medical Service Association ABD	$6,653.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,653.89
Rate for Payer: Kaiser Permanente Medicaid	$6,653.89
Rate for Payer: Ohana Health Plan Medicaid	$6,653.89
Rate for Payer: UnitedHealthcare Medicaid	$6,653.89

CETUXIMAB 100 MG/50 ML IV SOLN

Facility

$1,976.58

Service Code	HCPCS J9055
Hospital Revenue Code	636
Min. Negotiated Rate	$78.47
Max. Negotiated Rate	$1,917.28
Rate for Payer: Ohana Health Plan Medicaid	$88.51
Rate for Payer: AlohaCare Medicaid	$80.46
Rate for Payer: AlohaCare Medicare	$80.46
Rate for Payer: Cash Price	$1,284.78
Rate for Payer: Cash Price	$1,284.78
Rate for Payer: Devoted Health Medicare	$88.51
Rate for Payer: Hawaii Medical Service Association ABD	$78.47
Rate for Payer: Hawaii Medical Service Association Commercial	$100.58
Rate for Payer: Hawaii Medical Service Association Medicare	$80.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$78.47
Rate for Payer: Hawaii Western Management Group Commercial	$1,877.75
Rate for Payer: Health Management Network Commercial	$1,680.09
Rate for Payer: Humana Medicare	$80.46
Rate for Payer: Kaiser Permanente Commercial	$1,245.25
Rate for Payer: Kaiser Permanente Medicaid	$1,008.06
Rate for Payer: Kaiser Permanente Medicare	$80.46
Rate for Payer: MDX Hawaii PPO	$1,917.28
Rate for Payer: Ohana Health Plan Medicare	$80.46
Rate for Payer: UnitedHealthcare Medicaid	$1,185.95
Rate for Payer: UnitedHealthcare Medicare	$80.46
Rate for Payer: University Health Alliance Commercial	$1,440.73

CETUXIMAB 100 MG/50 ML IV SOLN

Facility

$1,976.58

Service Code	HCPCS J9055
Hospital Revenue Code	250
Min. Negotiated Rate	$1,680.09
Max. Negotiated Rate	$1,917.28
Rate for Payer: Cash Price	$1,284.78
Rate for Payer: Health Management Network Commercial	$1,680.09
Rate for Payer: MDX Hawaii PPO	$1,917.28

CETUXIMAB 200 MG/100 ML IV SOLN

Facility

$3,126.00

Service Code	HCPCS J9055
Hospital Revenue Code	250
Min. Negotiated Rate	$2,657.10
Max. Negotiated Rate	$3,032.22
Rate for Payer: Cash Price	$2,031.90
Rate for Payer: Health Management Network Commercial	$2,657.10
Rate for Payer: MDX Hawaii PPO	$3,032.22

CETUXIMAB 200 MG/100 ML IV SOLN

Facility

$3,126.00

Service Code	HCPCS J9055
Hospital Revenue Code	636
Min. Negotiated Rate	$78.47
Max. Negotiated Rate	$3,032.22
Rate for Payer: AlohaCare Medicaid	$80.46
Rate for Payer: AlohaCare Medicare	$80.46
Rate for Payer: Cash Price	$2,031.90
Rate for Payer: Cash Price	$2,031.90
Rate for Payer: Devoted Health Medicare	$88.51
Rate for Payer: Hawaii Medical Service Association ABD	$78.47
Rate for Payer: Hawaii Medical Service Association Commercial	$100.58
Rate for Payer: Hawaii Medical Service Association Medicare	$80.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$78.47
Rate for Payer: Hawaii Western Management Group Commercial	$2,969.70
Rate for Payer: Health Management Network Commercial	$2,657.10
Rate for Payer: Humana Medicare	$80.46
Rate for Payer: Kaiser Permanente Commercial	$1,969.38
Rate for Payer: Kaiser Permanente Medicaid	$1,594.26
Rate for Payer: Kaiser Permanente Medicare	$80.46
Rate for Payer: MDX Hawaii PPO	$3,032.22
Rate for Payer: Ohana Health Plan Medicaid	$88.51
Rate for Payer: Ohana Health Plan Medicare	$80.46
Rate for Payer: UnitedHealthcare Medicaid	$1,875.60
Rate for Payer: UnitedHealthcare Medicare	$80.46
Rate for Payer: University Health Alliance Commercial	$2,278.54

CHANGE OF CYSTOSTOMY TUBE; SIMPLE

Facility

$2,837.00

Service Code	CPT 51705
Hospital Revenue Code	360
Min. Negotiated Rate	$49.55
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$295.16
Rate for Payer: AlohaCare Medicare	$295.16
Rate for Payer: Devoted Health Medicare	$324.68
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$295.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Humana Medicare	$295.16
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$295.16
Rate for Payer: Ohana Health Plan Medicaid	$324.68
Rate for Payer: Ohana Health Plan Medicare	$295.16
Rate for Payer: UnitedHealthcare Medicaid	$49.55
Rate for Payer: UnitedHealthcare Medicare	$295.16

CHARGE CONVERSION

Facility

$295.00

Hospital Charge Code	H7777777
Hospital Revenue Code	272
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$286.15
Rate for Payer: Cash Price	$191.75
Rate for Payer: Hawaii Western Management Group Commercial	$280.25
Rate for Payer: Health Management Network Commercial	$250.75
Rate for Payer: Kaiser Permanente Commercial	$185.85
Rate for Payer: Kaiser Permanente Medicaid	$150.45
Rate for Payer: MDX Hawaii PPO	$286.15
Rate for Payer: University Health Alliance Commercial	$215.03

CHARGE CONVERSION

Facility

$295.00

Hospital Charge Code	H7777777
Hospital Revenue Code	272
Min. Negotiated Rate	$250.75
Max. Negotiated Rate	$286.15
Rate for Payer: Cash Price	$191.75
Rate for Payer: Health Management Network Commercial	$250.75
Rate for Payer: MDX Hawaii PPO	$286.15

Know your out-of-pocket cost for care.

All Charges